The 66-year-old patient presented with periodontal problems, and she requested a restoration of the posterior region of the lower mandible. After extraction of teeth 35, 37, 45 and 47, which were not worth retaining, the bone proved to have a horizontal and vertical volume deficit in both posterior regions.
The bone was augmented using a 1:1 mixture of autologous bone chips (retromolar removal) and Geistlich Bio-Oss®, as well as a titanium scaffold produced specifically for the patient (Yxoss CBR®). A Geistlich Bio-Gide® collagen membrane shielded the graft from the soft tissue. A dual-sided split-flap permitted a tension-free wound closure and allowed a sufficiently wide keratinized mucosa to form later in the implant area.
After six months, the soft tissue conditions were clinically stable and free of any dehiscences. A ridge incision from position 5 to 7 was selected for the removal of the grid structure. After loosening the fixing screw, the grid structure could be separated carefully into two parts by applying small extrusion movements to the target breakpoint with a periostal elevator and be removed. The implants (Camlog, Screw Line®) were then inserted into the regions 35, 36, 37 and 45, 46, 47.
Why has this particular treatment been chosen?
In such a complication it is crucial to wait until the tissue has completely healed. The waiting period prior to the second augmentation was three months. In the event of major bone defects the bone shield technique described by Prof.Khoury produces predictable results for 3D alveolar ridge regeneration and, compared to cortical block augmentation, vital regeneration.